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1.
Angiology ; 71(3): 249-255, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31808357

RESUMO

Contrast-induced nephropathy (CIN) is one of the most important complications after invasive cardiovascular procedures. The neutrophil-to-lymphocyte ratio (NLR), mean platelet volume-to-lymphocyte ratio (MPVLR), and platelet-to-lymphocyte ratio (PLR) may be markers of the risk of CIN. We aimed to investigate the association of these indices with the development of CIN in patients with ST-elevation myocardial infarction and non-ST-elevation-acute coronary syndrome who underwent percutaneous coronary intervention. We retrospectively collected the data of patients with ACS after coronary angiography (CA); 564 patients were included (mean age, 62.3 ± 13.0 years; 41.1% female). We compared 62 (10.9%) patients who developed CIN and 502 patients who did not, after CA in terms of NLR, PLR, and MPVLR. Patients who developed CIN had significantly higher MPVLR, NLR, and PLR; the MPVLR (P ≤ .001) was an independent predictor of CIN. NLR, MPVLR, and PLR are simple, cheap, and easily accessible tests that can predict CIN; the MPVLR was the strongest of these predictors.


Assuntos
Síndrome Coronariana Aguda/fisiopatologia , Angiografia Coronária , Neutrófilos/citologia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Adulto , Idoso , Plaquetas/citologia , Angiografia Coronária/métodos , Feminino , Humanos , Masculino , Volume Plaquetário Médio/métodos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/metabolismo , Intervenção Coronária Percutânea/métodos , Insuficiência Renal/diagnóstico , Insuficiência Renal/metabolismo , Estudos Retrospectivos , Fatores de Risco
2.
Expert Opin Investig Drugs ; 29(1): 33-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31869253

RESUMO

Introduction: Despite current guideline-based, secondary prevention strategies in patients with the acute coronary syndrome, the residual ischemic risk is still at an unacceptable rate, and there is a concomitant high bleeding event rate. These observations mandate investigations of novel treatment strategies to meet the unmet need to improve outcomes in patients with ACS.Areas covered: In this review, the author(s) focus on new agents with ongoing or recently completed phase II trials for the treatment of ACS. We searched MEDLINE and clinicaltrials.org for Phase II trials in ACS patients, and important original investigations are reviewed.Expert opinion: Some of the novel drugs evaluated in the Phase II trials hold promise for future therapies such as AZD5718, anakinra, tocilizumab, CSL112, MEDI 6102, inclisiran, PZ128, selatogrel, and RVX-208. Their efficacy and safety should be evaluated in large scale Phase III trials. The higher cost of the drug will be a major limitation for wide-spread use of novel agents in general practice in future.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Desenvolvimento de Medicamentos , Drogas em Investigação/farmacologia , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/prevenção & controle , Animais , Ensaios Clínicos Fase II como Assunto , Drogas em Investigação/efeitos adversos , Humanos , Guias de Prática Clínica como Assunto , Prevenção Secundária/métodos
3.
Vasc Health Risk Manag ; 15: 301-308, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31616150

RESUMO

Objective: We aimed to characterize patients after an acute cardiac event regarding their negative expectations around returning to work and the impact on work capacity upon discharge from cardiac rehabilitation (CR). Methods: We analyzed routine data of 884 patients (52±7 years, 76% men) who attended 3 weeks of inpatient CR after an acute coronary syndrome (ACS) or cardiac surgery between October 2013 and March 2015. The primary outcome was their status determining their capacity to work (fit vs unfit) at discharge from CR. Further, sociodemographic data (eg, age, sex, and education level), diagnoses, functional data (eg, exercise stress test and 6-min walking test [6MWT]), the Hospital Anxiety and Depression Scale (HADS) and self-assessment of the occupational prognosis (negative expectations and/or unemployment, Würzburger screening) at admission to CR were considered. Results: A negative occupational prognosis was detected in 384 patients (43%). Out of these, 368 (96%) expected not to return to work after CR and/or were unemployed before CR at 29% (n=113). Affected patients showed a reduced exercise capacity (bicycle stress test: 100 W vs 118 W, P<0.01; 6MWT: 380 m vs 421 m, P<0.01) and were more likely to receive a depression diagnosis (12% vs 3%, P<0.01), as well as higher levels on the HADS. At discharge from CR, 21% of this group (n=81) were fit for work (vs 35% of patients with a normal occupational prognosis (n=175, P<0.01)). Sick leave before the cardiac event (OR 0.4, 95% CI 0.2-0.6, P<0.01), negative occupational expectations (OR 0.4, 95% CI 0.3-0.7, P<0.01) and depression (OR 0.3, 95% CI 0.1-0.8, P=0.01) reduced the likelihood of achieving work capacity upon discharge. In contrast, higher exercise capacity was positively associated. Conclusion: Patients with a negative occupational prognosis often revealed a reduced physical performance and suffered from a high psychosocial burden. In addition, patients' occupational expectations were a predictor of work capacity at discharge from CR. Affected patients should be identified at admission to allow for targeted psychosocial care.


Assuntos
Síndrome Coronariana Aguda/reabilitação , Reabilitação Cardíaca , Motivação , Alta do Paciente , Pacientes/psicologia , Retorno ao Trabalho , Avaliação da Capacidade de Trabalho , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/psicologia , Adulto , Comorbidade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
5.
Int J Med Sci ; 16(8): 1171-1179, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31523180

RESUMO

AIM: To investigate the association between plasma S100A1 level and ST-segment elevation myocardial infarction (STEMI) and potential significance of S100A1 in post-infarction cardiac function. METHODS: We examined the plasma S100A1 level in 207 STEMI patients (STEMI group) and 217 clinically healthy subjects for routine physical examination without a history of coronary artery disease (Control group). Baseline characteristics and concentrations of relevant biomarkers were compared. The relationship between S100A1 and other plasma biomarkers was detected using correlation analysis. The predictive role of S100A1 on occurrence of STEMI was then assessed using multivariate ordinal regression model analysis after adjusting for other covariates. RESULTS: The plasma S100A1 level was found to be significantly higher (P<0.001) in STEMI group (3197.7±1576.0 pg/mL) than in Control (1423.5±1315.5 pg/mL) group. Furthermore, the correlation analysis demonstrated plasma S100A1 level was significantly associated correlated with hypersensitive cardiac troponin T (hs-cTnT) (r = 0.32; P < 0.001), creatine kinase MB (CK-MB) (r = 0.42, P < 0.001), left ventricular eject fraction (LVEF) (r = -0.12, P = 0.01), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (r = 0.61; P < 0.001) and hypersensitive C reactive protein (hs-CRP) (r = 0.38; P < 0.001). Moreover, the enrolled subjects who with a S100A1 concentration ≤ 1965.9 pg/mL presented significantly better cardiac function than the rest population. Multivariate Logistic regression analysis revealed that S100A1 was an independent predictor for STEMI patients (OR: 0.671, 95% CI 0.500-0.891, P<0.001). In addition, higher S100A1 concentration (> 1965.9 pg/mL) significantly increased the risk of STEMI as compared with the lower level (OR: 6.925; 95% CI: 4.15-11.375; P<0.001). CONCLUSION: These results indicated that the elevated plasma S100A1 level is an important predictor of STEMI in combination with several biomarkers and also potentially reflects the cardiac function following the acute coronary ischemia.


Assuntos
Proteínas S100/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Creatina Quinase Forma MB/sangue , Ecocardiografia Doppler , Feminino , Testes de Função Cardíaca , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Troponina T/sangue
6.
Biomed Res Int ; 2019: 8541402, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317040

RESUMO

Objective: The underlying mechanisms by which cystatin C affects cardiovascular disease (CVD) are not very clear. Metabolic syndrome (MetS) is a cluster of risk factors that increase the risk of CVD. Here, we aimed to investigate the association of cystatin C with metabolic syndrome and cardiovascular outcomes in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with preserved renal function. Methods: In total, 422 NSTE-ACS patients with preserved renal function were enrolled to examine the association of cystatin C with MetS. MetS was defined based on the NCEP-ATP-III guidelines. Major adverse cardiovascular events (MACEs) were also evaluated, which included cardiac death, nonfatal myocardial infarction (MI), target vessel revascularization (TVR), heart failure, and nonfatal stroke. All patients underwent a 12-month follow-up for MACEs after admission. Results: Cystatin C was significantly correlated with metabolic risk factors and inflammation markers. The prevalence of MetS and MACEs correlated with cystatin C levels. Cystatin C showed a strong diagnostic performance for cardiovascular risk factors and outcomes in ROC analysis. After adjustment for multiple risk factors, cystatin C level was independently associated with MetS (OR 2.299, 95% CI 1.251-4.225, and P = 0.007). During a 12-month follow-up, the patients with high cystatin C level and MetS had higher incidence of MACEs (Log-rank = 24.586, P < 0.001) and cardiac death (Log-rank = 9.890, P = 0.020) compared to the others. Multivariate Cox analysis indicated that cystatin C level was an independent predictor of MACEs (HR 2.609, 95% CI 1.295-5.257, and P = 0.007). Conclusion: Cystatin C may be an independent predictor of metabolic syndrome and therefore valuable for management of NSTE-ACS patients. Further multicenter, large-scale studies are required to assess the implication of these results.


Assuntos
Cistatina C/sangue , Insuficiência Cardíaca/sangue , Síndrome Metabólica/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Biomarcadores/sangue , Eletrocardiografia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Rim/metabolismo , Rim/fisiologia , Masculino , Síndrome Metabólica/complicações , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Prognóstico , Curva ROC , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia
7.
Geriatr Psychol Neuropsychiatr Vieil ; 17(3): 271-278, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31339491

RESUMO

The SEGA instrument has demonstrated good performance in screening for frailty. However, its predictive ability in elderly patients presenting with acute coronary syndrome have never been evaluated. We aimed to study the prognostic value at one year of the frailty level assessed by the SEGA instrument, in a population of patients aged 80 years old or more hospitalised for acute coronary syndrome. All consecutive patients aged 80 years or older hospitalised for myocardial infarction type 1 between November 2016 and October 2017 were included. All underwent standardised geriatric assessment including estimation of frailty by the SEGA instrument. The primary outcome was the time to death from any cause. In all 64 patients were included for a mean age of 85.3±4 years. Using the SEGA instrument, 24% patients were classified "frail" and 44% "very frail"; 18 (28%) deaths were observed during follow-up. When adjusted for patient age, body mass index and arterial hypertension, survival status was not significantly related with frailty status (HR=1.1, 95% CI=0.4-3.1, p=0.8).


Assuntos
Síndrome Coronariana Aguda/fisiopatologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Síndrome Coronariana Aguda/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fragilidade/mortalidade , Humanos , Masculino , Infarto do Miocárdio/complicações , Infarto do Miocárdio/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
8.
J Cardiovasc Comput Tomogr ; 13(5): 242-247, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31345766

RESUMO

Despite decades of research and major innovations in technology, cardiovascular disease remains the leading cause of death globally. Our understanding of major cardiovascular events and their prevention is centred around the atherosclerotic plaque and the processes that ultimately lead to acute plaque rupture. Recent advances in hybrid imaging technology allow the combination of high spatial resolution and anatomical detail with molecular assessments of disease activity. This provides the ability to identify vulnerable plaque characteristics and differentiate active and quiescent disease, with the potential to improve patient risk stratification. Combined positron emission tomography and computed tomography is the prototypical non-invasive hybrid imaging technique for coronary artery plaque assessment. In this review we discuss the current state of play in the field of hybrid coronary atherosclerosis imaging.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Imagem Multimodal/métodos , Placa Aterosclerótica , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/terapia , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Vasos Coronários/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico , Humanos , Imagem por Ressonância Magnética , Imagem de Perfusão do Miocárdio , Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença
9.
Pan Afr Med J ; 32: 138, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303911

RESUMO

The occurrence of an acute coronary syndrome (ACS) with an anomalous connection of coronary artery (ANOCOR) identified as a culprit artery is very rare. This association may lead in some anatomical forms to a delay in coronary reperfusion. We report the clinical case of a patient admitted for high-risk Non ST elevation myocardial infarction (NSTEMI) in whom coronary angiography accidentally discovers an anomalous connection of the left coronary network from the right anterior. In light of this case and a review of literature, we discuss the peculiarities of these anomalous connections.


Assuntos
Síndrome Coronariana Aguda/fisiopatologia , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Idoso , Humanos , Masculino
10.
Pan Afr Med J ; 32: 104, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223394

RESUMO

Introduction: acute coronary syndromes (ACSs) have been increasing in sub-Saharan Africa. Coronary angiography data have been rarely reported. This study aims to investigate coronary lesions observed in patients with acute coronary syndromes (ACS) in Abidjan. Methods: we conducted a cross-sectional study from 1st January 2010 to 31st December 2014. All patients with ACS admitted to the Abidjan Heart Institute and undergoing coronary angiography during the study period were included. Two hundred and fifty-six patients were selected. We investigated and compared coronary lesions in patients with ACS associated with persistent ST-segment elevation (ACS ST+) and in those with ACS without ST-segment elevation (ACS ST-). Results: the average age of patients was 53.2 ± 10.8 years; there was a male predominance, with a sex ratio of 6.1. Abnormal coronary angiography rate was significantly higher in the STEMI group (95.4% and 64.2% respectively, p < 0.001). Three hundred and four coronary lesions were found in the STEMI group against 43 in the NSTE-ACS group. Stenotic lesions were predominantly one-vessel disease (45.3%) in the STEMI group and two or three-vessel disease in the NSTE-ACS group (68.0%). Type B1 lesions were more common in the NSTE-ACS group (62.8% versus 36.5%, p = 0.002). The most complex type C lesions were more commonly found in the STEMI group (17.8%), with no significant difference. The majority of patients had SYNTAX score less than 22, whatever the type of ACS (87.4% in the STEMI group and 90.1% in the NSTE-ACS group). Conclusion: coronary lesions in the patients group with STEMI were predominantly one-vessel disease and they were more diffuse in the NSTE-ACS group, but with a higher proportion of angiographically normal coronary arteries. The management of patients with these lesions is based in the majority of cases on coronary angioplasty.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Grupo com Ancestrais do Continente Africano , Angiografia Coronária/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/fisiopatologia , Adulto , Idoso , Costa do Marfim/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia
11.
Nutr Metab Cardiovasc Dis ; 29(7): 718-727, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31151882

RESUMO

BACKGROUND AND AIMS: Predictive and prognostic ability of muscle mass in CVD settings is increasingly discussed. The gender-specific effect of skeletal muscle mass index (SMI) on 10-year recurrent fatal/non fatal cardiovascular disease (CVD) event of acute coronary syndrome (ACS) patients was evaluated. METHODS AND RESULTS: In 2006-2009, n = 1000 consecutive patients (n = 222 women), hospitalized at the First Cardiology Clinic of Athens with ACS diagnosis and with symptoms and left ventricular function indicative of heart failure were selected. SMI was created to reflect skeletal muscle mass through appendicular skeletal muscle mass (indirectly calculated through population formulas) divided by body mass index (BMI). In the 10-year follow-up (2016), 55% of ACS patients experienced recurrent fatal/non fatal CVD events (53% in women vs.62% in men, p = 0.04). Patients in the 2nd SMI tertile (mostly overweight) had 10% lower risk for CVD recurrence (women:men rate ratio = 0.87) over their counterparts in the 1st (mostly normalweight) and 3rd tertile (mostly obese). Multivariate analysis revealed that ACS patients in the 2nd SMI tertile presented 46% and 85% lower CVD event risk over their counterparts in the 1st tertile (Hazard Ratio (HR) = 0.54, 95% Confidence Interval (95% CI) 0.30, 0.96, p = 0.002) and 3rd tertile (HR = 1.85, 95%CI 1.05, 2.94, p = 0.03). Gender-based analysis revealed that this trend remained significant only in women. Inflammatory markers had strong confounding effect. CONCLUSION: A U-shape association between SMI and 10-year CVD event especially in women was highlighted. This work reveals gender-specific remarks for "obesity-lean paradox" in secondary prevention, implying that high muscle mass accompanied by obesity and excess adiposity may not guarantee better prognosis.


Assuntos
Síndrome Coronariana Aguda/fisiopatologia , Composição Corporal , Insuficiência Cardíaca/fisiopatologia , Músculo Esquelético/fisiopatologia , Obesidade/fisiopatologia , Função Ventricular Esquerda , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Adiposidade , Idoso , Índice de Massa Corporal , Causas de Morte , Feminino , Grécia/epidemiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/mortalidade , Prognóstico , Estudos Prospectivos , Recidiva , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
12.
J Cardiovasc Comput Tomogr ; 13(4): 196-202, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31113728

RESUMO

BACKGROUND: Non-invasive fractional flow reserve (FFRCT) derived from coronary computed tomography angiography (CTA) permits hemodynamic evaluation of coronary stenosis and may improve efficiency of assessment in stable chest pain patients. We determined feasibility of FFRCT in the population of acute chest pain patients and assessed the relationship of FFRCT with outcomes of acute coronary syndrome (ACS) and revascularization and with plaque characteristics. METHODS: We included 68 patients (mean age 55.8 ±â€¯8.4 years, 71% men) from the ROMICAT II trial who had ≥50% stenosis on coronary CTA or underwent additional non-invasive stress test. We evaluated coronary stenosis and high-risk plaque on coronary CTA. FFRCT was measured in a core laboratory. RESULTS: We found correlation between anatomic severity of stenosis and FFRCT ≤0.80 vs. FFRCT >0.80 (severe stenosis 84.8% vs. 15.2%; moderate stenosis 33.3% vs. 66.7%; mild stenosis 33.3% vs. 66.7% patients). Patients with severe stenosis had lower FFRCT values (median 0.64, 25th-75th percentile 0.50-0.75) as compared to patients with moderate (median 0.84, 25th-75th percentile, p < 0.001) or mild stenosis (median 0.86, 25th-75th percentile 0.78-0.88, p < 0.001). The relative risk of ACS and revascularization in patients with positive FFRCT ≤0.80 was 4.03 (95% CI 1.56-10.36) and 3.50 (95% CI 1.12-10.96), respectively. FFRCT ≤0.80 was associated with the presence of high-risk plaque (odds ratio 3.91, 95% CI 1.55-9.85, p = 0.004) after adjustment for stenosis severity. CONCLUSION: Abnormal FFRCT was associated with the presence of ACS, coronary revascularization, and high-risk plaque. FFRCT measurements correlated with anatomic severity of stenosis on coronary CTA and were feasible in population of patients with acute chest pain.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Angina Pectoris/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/terapia , Angina Pectoris/fisiopatologia , Angina Pectoris/terapia , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , Valor Preditivo dos Testes , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença
13.
Rev Port Cardiol ; 38(4): 281-286, 2019 04.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31109760

RESUMO

INTRODUCTION AND OBJECTIVES: To describe the progression of aerobic exercise intensity in patients on a cardiac rehabilitation (CR) program. METHODS: We conducted a retrospective analysis of a random sample of patients referred for CR after acute coronary syndrome between 2008 and 2016. The weekly peak exercise intensity achieved during aerobic exercise was estimated by treadmill speed and grade at peak effort and the corresponding perception of effort was assessed using the Borg scale. Initial exercise intensity was prescribed as 60-80% of reserve heart rate plus resting heart rate, and was modified according to perceived exertion. Peak heart rate/intensity and perceived exertion index were used as variables to characterize the response to the intensity achieved. Variables were compared at different time points: T1 (1st week), T2 (4th week) and T3 (8th week). RESULTS: Of the total of 868, 238 patients were randomly selected. At peak heart rate during the session, exercise intensity (in metabolic equivalents) was: T1: 7.2±2.0, T2: 9.0±2.2, and T3: 9.4±2.2 (p<0.01). The peak heart rate/intensity index was T1: 16.8±5.4, T2: 13.4±3.6 and T3: 13.1±3.8 (p<0.01) and the perceived exertion index was T1: 1.8±0.6; T2: 1.4±0.5; T3: 1.4±0.5 (p<0.01). CONCLUSIONS: Increasing exercise intensity during CR, associated with lower perception of effort and lower heart rate necessary to achieve such intensity, leads to significant improvement in functional capacity.


Assuntos
Síndrome Coronariana Aguda/reabilitação , Reabilitação Cardíaca/métodos , Terapia por Exercício/métodos , Tolerância ao Exercício/fisiologia , Síndrome Coronariana Aguda/fisiopatologia , Teste de Esforço , Feminino , Seguimentos , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Estudos Retrospectivos
14.
Acta Med Indones ; 51(1): 3-9, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31073100

RESUMO

BACKGROUND: some studies show fragmanted QRS (fQRS) as a marker of myocardial scar, ventricular arrhythmia, ventricular remodelling and worse coronary collaterals flow, which can increase the incidence of major adverse cardiac event (MACE) after infarction. This study aimed to identify the role of fQRS as one of the risk factors for MACE (cardiac death and reinfarction) in acute coronary syndrome patients within 30 days observation. METHODS: a cohort retrospective study was conducted using secondary data of acute coronary syndrome patients at Intensive Cardiac Care Unit Cipto Mangunkusumo Hospital from July 2015 to October 2017. Multivariate analysis were done by using logistic regression with GRACE score (moderate and high risk), low eGFR (< 60 ml/min), low LVEF (< 40%), diabetes mellitus, age more than 45 years and hypertension as confounding factors. RESULTS: three hundred and fifty three (353) subjects were included. Fragmented QRS was found in 60,9 % subjects. It was more frequent in inferior leads (48.8% ) with mean onset of 34 hours. Major adverse cardiac events were higher in fQRS vs. non-fQRS group (15.8% vs. 5.8 %). Bivariate analysis showed higher probability of 30 days MACE in fQRS group (RR 2.72; 95%CI 1.3 -5.71p=0.08). Multivariate analysis revealed adjusted RR of 2.79 (95% CI: 1.29 - 4.43, p<0.05). Low eGFR was a potential confounder in this study. CONCLUSION: persistent fQRS developed in ACS during hospitalization is an independent predictor of 30 days MACE cardiac death and re-infarction.


Assuntos
Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Arritmias Cardíacas/diagnóstico , Eletrocardiografia , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Arritmias Cardíacas/etiologia , Biomarcadores , Feminino , Taxa de Filtração Glomerular , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Fatores de Risco
16.
Medicina (Kaunas) ; 55(5)2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31137601

RESUMO

Background and objectives: Despite being within the normal reference range, changes in thyroid stimulating hormone (TSH) levels have negative effects on the cardiovascular system. The majority of patients admitted to hospital with acute coronary syndrome (ACS) are euthyroid. The aim of this study was to investigate the effect of TSH level on the prognosis of in-hospital and follow-up periods of euthyroid ACS patients. Materials and Methods: A total of 629 patients with acute coronary syndrome without thyroid dysfunction were included in the study. TSH levels of patients were 0.3-5.33 uIU/mL. Patients were divided into three TSH tertiles: TSH level between (1) 0.3 uIU/mL and <0.90 uIU/mL (n = 209), (2) 0.90 uIU/mL and <1.60 uIU/mL (n = 210), and (3) 1.60 uIU/mL and 5.33 uIU/mL (n = 210). Demographic, clinical laboratory, and angiographic characteristics were compared between groups in terms of in-hospital and follow-up prognosis. Results: Mean age was 63.42 ± 12.5, and 73.9% were male. There was significant difference between tertiles in terms of TSH level at admission (p < 0.001), the severity of coronary artery disease (p = 0.024), in-hospital mortality (p < 0.001), in-hospital major hemorrhage (p = 0.005), total adverse clinical event (p = 0.03), follow-up mortality (p = 0.022), and total mortality (p < 0.001). In multivariate logistic regression analysis, the high-normal TSH tertile was found to be cumulative mortality increasing factor (OR = 6.307, 95%; CI: 1.769-22.480; p = 0.005) during the 6-month follow-up period after hospitalization and discharge. Conclusions: High-normal TSH tertile during hospital admission in euthyroid ACS patients is an independent predictor of total mortality during the 6-month follow-up period after hospitalization and discharge.


Assuntos
Síndrome Coronariana Aguda/sangue , Tireotropina/análise , Fatores de Tempo , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Valores de Referência , Estudos Retrospectivos , Tireotropina/sangue , Turquia/epidemiologia
17.
Int J Cardiovasc Imaging ; 35(10): 1811-1821, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31093895

RESUMO

No-reflow (NR) is one of the major complications of primary percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We aim to assess the value of multilayer longitudinal strain parameter to predict NR in patients with NSTEMI and preserved ejection fraction. 230 consecutive patients who were admitted to the emergency department and diagnosed with NSTEMI were prospectively included in this study. Echocardiography was performed 1 h before angiography. Specific analysis for endocardial, mid-myocardial and epicardial layers were performed by two-dimensional (2D) speckle tracking echocardiography (STE) for multilayer longitudinal strain. NR was described as flow grade of ≤ TIMI 2 when mechanical occlusions like dissection, intimal tear, arterial spasm and thromboembolism during angiography were excluded. 49 of 168 patients admitted to the study had NR. No significant differences were observed between the groups regarding age and gender. Multilayer longitudinal strain imaging (endocard, midmyocard and epicard) revealed lower strain values particularly in endocardial layer in patients with NR (GLS-endocard: - 14.14 ± 1.39/- 17.41 ± 2.34, p < 0.001; GLS-midmyocard: - 14.81 ± 1.40/17.81 ± 2.22, p < 0.001; GLS-epicard: - 16.14 ± 1.38/18.22 ± 2.00, p < 0.001). GLS-endocard, GLS-midmyocard, GLS-epicard and ST depression were found to be statistically significant independents parameters respectively to predict NR phenomenon (GLS-endocard: OR: 2.193, p < 0.001; GLS-midmyocard: OR: 1.510, p: 0.016; GLS-epicard: OR: 1.372, p: 0.035; ST depression: OR: 3.694, p: 0.014). We revealed that left ventricular strain study with speckle tracking echocardiography predicts NR formation. This noninvasive method may be useful for detecting NR formation in patients with NSTEMI.


Assuntos
Síndrome Coronariana Aguda/terapia , Estenose Coronária/terapia , Ecocardiografia Doppler de Pulso , Fenômeno de não Refluxo/etiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Intervenção Coronária Percutânea/efeitos adversos , Função Ventricular Esquerda , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/fisiopatologia , Adulto , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenômeno de não Refluxo/diagnóstico por imagem , Fenômeno de não Refluxo/fisiopatologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
18.
J Ayub Med Coll Abbottabad ; 31(2): 151-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31094106

RESUMO

BACKGROUND: Increasing affection of younger patients with ischemic heart disease is an enhanced concern in developing Asian nations. This study elaborates the morphology and distribution of coronary lesions in young Asians presenting with acute coronary syndrome (ACS). METHODS: Patients (aged ≤35 years) with (ACS) undergoing angiography were studied. Their angiographic disease was analysed to determine the common sites, severity and types (AHA and SCAI) of lesions. The association of LV dysfunction with lesion parameters was identified. Patients with cocaine or other drug abuse and valvular heart disease were excluded. RESULTS: Two hundred and twenty-one patients aged 16-35 (31.4±3.5) years were studied with predominant males (195, i.e., 88.2%). On angiography 51 (23.1%) patients showed normal coronaries while 108(48.9%) had single, 48 (21.7%) had double and 14 (6.3%) had multivessel disease. On the whole, involvement of left anterior descending artery (LAD) either singly or in combination with other vessels was seen in 146 (66%), right coronary artery (RCA) in 56 (25.3%), left circumflex (LCX) in 43 (19.5%) and left main stem in 06 (2.7%) of total patients. Regarding lesion characteristics, tight lesions (45.4%), AHA type-A (47.8%) and SCAI-I (70.1%) lesions were common. The mid segment was commonly involved in LAD and LCX while proximal segment in RCA. Severe LV dysfunction was associated with presence of LAD disease. CONCLUSIONS: Coronary angiograms can be normal in up to one fourth of young ACS patients. Others show a predominance of LAD artery involvement with morphologically simple lesions.


Assuntos
Síndrome Coronariana Aguda , Infarto do Miocárdio , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/fisiopatologia , Adolescente , Adulto , Estudos de Coortes , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/fisiopatologia , Adulto Jovem
20.
Eur Radiol ; 29(11): 6119-6128, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31025066

RESUMO

OBJECTIVES: We explored the anatomical, plaque, and hemodynamic characteristics of high-risk non-obstructive coronary lesions that caused acute coronary syndrome (ACS). METHODS: From the EMERALD study which included ACS patients with available coronary CT angiography (CCTA) before the ACS, non-obstructive lesions (percent diameter stenosis < 50%) were selected. CCTA images were analyzed for lesion characteristics by independent CCTA and computational fluid dynamics core laboratories. The relative importance of each characteristic was assessed by information gain. RESULTS: Of the 132 lesions, 24 were the culprit for ACS. The culprit lesions showed a larger change in FFRCT across the lesion (ΔFFRCT) than non-culprit lesions (0.08 ± 0.07 vs 0.05 ± 0.05, p = 0.012). ΔFFRCT showed the highest information gain (0.051, 95% confidence interval [CI] 0.050-0.052), followed by low-attenuation plaque (0.028, 95% CI 0.027-0.029) and plaque volume (0.023, 95% CI 0.022-0.024). Lesions with higher ΔFFRCT or low-attenuation plaque showed an increased risk of ACS (hazard ratio [HR] 3.25, 95% CI 1.31-8.04, p = 0.010 for ΔFFRCT; HR 2.60, 95% CI 1.36-4.95, p = 0.004 for low-attenuation plaque). The prediction model including ΔFFRCT, low-attenuation plaque and plaque volume showed the highest ability in ACS prediction (AUC 0.725, 95% CI 0.724-0.727). CONCLUSION: Non-obstructive lesions with higher ΔFFRCT or low-attenuation plaque showed a higher risk of ACS. The integration of anatomical, plaque, and hemodynamic characteristics can improve the noninvasive prediction of ACS risk in non-obstructive lesions. KEY POINTS: • Change in FFR CT across the lesion (ΔFFR CT ) was the most important predictor of ACS risk in non-obstructive lesions. • Non-obstructive lesions with higher ΔFFR CT or low-attenuation plaque were associated with a higher risk of ACS. • The integration of anatomical, plaque, and hemodynamic characteristics can improve the noninvasive prediction of ACS risk.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Hemodinâmica/fisiologia , Placa Aterosclerótica/diagnóstico , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Placa Aterosclerótica/fisiopatologia , Valor Preditivo dos Testes
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